Ostomies Flashcards
where to look for advice on if a med an be given via enteral feeding tube
enteral feeding tubes section in meds complete
what is the main focus of pharmacy advice with peg feeding tubes
ensure px continue to get their meds and nutrition
give an appropriate volume of water that can be used to flush a PEG tube before, after and in between administration of medicines
10ml
what type of syringe should be used for enteral feeding
enteral syringes
should drugs be mixed together for peg feeding yes or no
no
although switching to solution/ suspension ideal, tablets can be crushed and given via enteral tube when
if they are the only licensed product
what class of drugs is 5fu
antimetabolite
give a brief explanation of why chemotherapy is given alongside radiotherapy
sensitises tumour cells to radiotherapy
shrinks large tumours
helps stop spread of metastases
can be used after to kill residual cancer cells
why might patients have to wait a period of 6 weeks between completion of chemo radiotherapy and surgery
weakens immune system -> reduced wcc
would be at risk of thrombocytopenia and neutropenic sepsis
allows immune system to recover before surgery
what dietary advice can you give someone with a stoma that is experiencing constipation
increase fluid intake
eat wholemeal grains
brown bread and pasta
increase fruit and vegetable intake
who should you signpost patients with stomas to if their constipation does not resolve
stoma care nurse
is constipation more common for colostomy or ileostomy
colostomy
what classes of medications can cause constipation
calcium containing antacids or opioids
constipation can cause stoma prolapse and overflow diarrhoea, if identified who do patients need to be referred back to
surgical nursing support team
name one condition that you might wish to check in patients that have recently had a stoma relating to their mental health
depression
to deal with constipation you can increase faecal mass to distend the lower bowel and promote x
peristalsis
list some different bulking agents that could be used to manage constipation
methylcellulose
isphagula husk
sterculia
list some different osmotic laxatives that could be used to manage constipation
lactulose
macrogol
- retain water to inc stool volume
which type of laxative is a last resort
stimulant
name 2 stimulant laxatives that could be used as a last resort for constipation in stoma patients
Bisacodyl
docusate
what consideration should be made to the dose of stimulant laxatives
smallest dose to give a soft formed stool
why should stimulant laxatives not routinely be given to stoma patients
adaptation of stoma
what advice can you give to stoma patients about air travel for the first time
hydration
loperamide
rehydration salts
drainable and non drainable appliances
pre cut pouches
impregnanted wipes
adhesive removers
disposal bags
ensure pouch filter is working before flight
patients should work out how many pouches are needed for holiday and then x the number and pack some extras
double
if patients wear a closed stoma pouch why might they want to opt for a drainable one on holiday
in case of tummy bugs or looser stools
why might patients want to take a travel certificate or letter explaining their condition with them
get through security easier
what can be done to stoma bags if they cause ballooning due to pressure change
release gas or change pouch
drug class of mesalazine
aminosalicylate
how does mesalazine work to treat IBS etc
modulation of prostaglandin and leukotrines which are chemical mediators of inflammatory response, act locally, reduce inflammation in intestine lining
what is the drug class of azathioprine
immunosuppressant
moa of immunosuppressanst such as azathioprine
suppress IS, reduce inflamation, preventing rejection in organ transplantation
azathioprine is usually titrated from what drug class
corticosteroids
corticosteroids suppress leukotrines etc for crohns/UC and usually work in the first instance but eventually become
steroid resistant
what monitoring is required azathioprine
toxicity throughout
fbc weekly first 4 weeks then every 3 months
what are you looking for in blood tests when monitoring azathioprine
neutrophil and platelet depletion
what toxicity/ warning signs are you checking for in the entirety of azathioprine therapy
myelosuppression
for mesalazine renal function should be monitored how often
before treatment, at 3 months and then annually
a rare issue that can occur with mesalzine use is agranulocytosis, what warning signs should you look out for
unexplained bruising
bleeding
tiredness
malaise
what enzyme metabolises azathioprine
tpmt
why might patients with low levels of tpmt on azathioprine need low levels of the drug compared to patients with normal enzyme levels
myelosuppression
what screening can give an indication to azathioprine response but may not necessarily change treatment options and outcomes
tpmt
infliximab, adalimumab and golimumab are all examples of monoclonal antibodies, how do they work
binds to tnf alpha to reduce inflammation and prevent damage to cells lining the gut
what JAK inhibitor may be used to treat these conditions
tofacitinib
what integrin binding drug may be used in these conditions
vedolizumab
what interleukin binding drug may be used in these conditions
ustekinumab
ustekinumab
Ulcerative colitis
many patients dont need any pharmacological therapy after subtotal colectomy, but for those that do for rectal inflammation what may be given
steroid enemas or suppositories
what food factors can aggravate stomas and cause them to become sore with more liquid output
beans
chocolate
spicy food
raw fruit
spinach
sweeteners
true or false excessive consumption of beer or lager can irritate stomas
true
2 drugs or classes of drugs that can cause liquid outputs and irritate stomas
magnesium containing antacids and methyldopa
blockage can give symptoms of diarrhoea as solids are bypassed by liquids in the bowel, what would make you rule this out
extreme pain, sometimes watery output and px wont be able to stand
what drugs should NEVER be used in the event of blockages
laxatives
what drug can be used to manage diarrhoea in stomas even in high doses outside of its licence
loperamide
codeine use has been associated with x in the case of ostomies
intestinal obstruction
so avoid long term use
X in pouch can be used to reduce number of leaks
gelling agents
what advice can you give patients to deal with pouch leakage
change regularly
make sure secured when exercising
gently peel barrier from skin
take time
be gentle
ensure stoma stays clean
no perfume or cream on it
what can be used to protect broken peristomal skin
stoma powder
what leakage prevention products exist
skin barrier rings
paste
strips
what alternative methods of contraception may be suitable for patients aside from barrier methods
progesterone injections or birth control patch
how may oral contraceptive efficacy be altered in large bowel disease
unlikely reduced
how may oral contraceptive efficacy be altered in small bowel disease
possibly reduced
and malabsorption (crohns)
people with autoimmune disease are more/ less at risk of VTE
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